Determining the Relationship between Nurses Professional Ethics and Observance of Nursing Care Standards

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1 Indian Journal of Science and Technology, Vol 8(35), DOI: /ijst/2015/v8i35/86770, December 2015 ISSN (Print) : ISSN (Online) : Determining the Relationship between Nurses Professional Ethics and Observance of Nursing Care Standards Ghassem Abedi 1, Farideh Rostami 2 *, Aliasghar Nadi 3 and Nasim Taheri 4 1 Department of Health Care Management, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran; Iq134589@yahoo.com 2 MSc in Health Care Management, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran; rostamimaskopaii@gmail.com 3 Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran; statistic.nadi@gmail.com 4 Bu Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran; ijohssari@gmail.com Abstract Background and Objectives: As the largest group of healthcare providers and as professional individuals, nurses need to learn how to show ethical behavior in educational environment, which leads to an increase in wellbeing indices and patient satisfaction. Therefore, the present study was aimed at determining the relationship between the nurses professional ethics and observance of standards of nursing care in Bu Ali Sina Hospital, Sari in Materials and Methods: The statistical population of the present descriptive-analytical study consisted of all 144 nurses working in Bu Ali Sina Hospital, Sari, Iran. They were selected as the study sample based on Krejcie and Morgan Table. A researcher-designed instrument was employed in order to collect the required data. Descriptive statistics (mean and standard deviation) and inferential statistics (one-sample t-test) were employed to analyze the data. Results: The results of the study indicated that there was a significant relationship between professional ethical learning and standards of nursing care. Statistically, the collected data rejected the null hypothesis (H 0 ) at a confidence level of 95% (α = 0.05) and proved the study hypothesis. In other words, it can be claimed that there was a significant difference between the sample and the theoretical means. Conclusion: Since there is no appropriate relationship between ethical learning and standards of nursing care, it is necessary to evaluate the standards of nursing care and teach ethical principles constantly. Keywords: Care, Hospital, Nurse, Professional Ethics, Standard 1. Introduction Success in an organization is the result of applying professional ethics. Weakness in the system of ethics and tendency toward mistrust lead to a decrease in communications and an increase in organizational loss, and the management approaches retrospective control. Therefore, the organization will become negative, and professional ethics can play the role of a catalyst to rationalize the organization based on a humanistic attitude. In fact Professional ethics is an intellectual process which is aimed at actualizing what values should be developed and when they should be maintained 1,2. Different ethical principles, rules, and standards entitled codes of professional ethics or ethical charters are developed for many professions and jobs at organizational, national, and even global levels, and the owners of the professions need to abide by them. It seems that learning and applying ethics is more necessary in nursing than other professions because nurses are the largest group of healthcare providers in the health care system and their spiritual behavior along with responsibility can play and effective role in recovery of the patients 3, hence legally and morally, they have to beresponsive to the quality of care offered 4. Therefore, nursing is based on ethics. Observance of ethical principles in nursing profession leads to improved nursing services, and improved quality of nursing service can have a significant effect on patient s recovery. In clinical nursery, *Author for correspondence

2 Determining the Relationship between Nurses Professional Ethics and Observance of Nursing Care Standards Jormsri considers nursing care as a set of three major principles: ethics, clinical judgment, and care 5. Studies indicated that all nurses, regardless of their specialty, need training and guidance about clinical and ethical decision making. Availability of ethical guidelines can enhance the quality of the nurses performance in their profession and cause the integrity of knowledge-based performance that is based on ethical teachings in different situations 6. In this regard, Kyle identified nursing care and performance as a complicated phenomenon and suggests that care process consists of ethical, cognitive, and emotional components. Moreover, the nurses ability to make appropriate ethical decisions and follow a consistent pattern of professional ethics is necessary for acquiring the required training and knowledge in regard with ethical issues 7. In their study, Patenaude et al. concluded that ethical sensitivity was more among senior students than freshmen, which can be attributed to the effect of training and interacting with clinical environment on observance of ethical and professional standards 8. Moreover, Auvinen et al. studied the ethical judgment of freshmen and senior nursing students in Finland and the effect of ethical training on ethical judgment ability. They concluded that students who had practically encountered with ethical problems had better judgment compared to those who had not experienced such problems. In this study, senior students had better judgment than freshmen, and there was a significant difference between the two groups. This study indicated that training practical ethics can affect the students ethical judgement 9. Other researchers have highlighted the effect of training on ethical sensitivity. They believed that the lack of ethical training could impede the development of ethics in profession and ethical sensitivity The study conducted by Wehrwein indicated that training ethics was effective in students awareness of ethical issues and their application in working environment. Moreover, the capacity to make ethical decisions was higher among students who had passed Ethics course than those who had not 14. Rodmell considered curriculum-based ethical teachings as effective factors in forming the individuals attitude, increasing their knowledge, and creating a framework for discussion and criticism. He stated that ethical knowledge is an important issue in nursery and that implementing ethical issues in curricula can enhance ethical problems and judgment 15. In a qualitative study was aimed at investigating and describing B.Sc. nursing students experience of internalized values and practical adherence to professional ethics, Kelly concluded that teaching the principles of professional ethics had a remarkable effect on forming professional ethics among nursing students 16. After the issue of professional ethics was explained and the importance of observing nursing standards was justified through the above mentioned points, the present study was conducted in order to come up with a better understanding of the relationship between professional ethics teaching among nurses and observance of nursing standards based of the managers views in order to explain and determine this relationship because nurses account for a large portion of the health care providers and play an important role in quality of health and medical care. Moreover, knowledge about ethical criteria is an effective factor in providing quality health care. 2. Method In regard with its objectives, the present study was an applied, descriptive, and analytical research. It was carried out in order to determine the relationship between the nurses knowledge of professional ethics and the observance rate of nursing care standards from the perspective of hospital managers in The study consisted of nurses in Bu Ali Hospital of Sari. Inclusion criterion included a minimum experience of three years in hospital, and exclusion criterion was failure to respond to all items of the questionnaire. The size of the study sample was determined to be 144 nurses based on Krejcie and Morgan Table. They were chosen using stratified random sampling (each specialized ward was considered as stratification). The study instrument was a researcher-designed questionnaire measuring the nurses professional ethics in four domains: specialized and clinical (5 items), nurse as managers (2 items), nurse as instructor (3 items), and nurse as researcher (3 items) which were designed on three scales of weak, average, and excellent. The inventory for observance of nursing standards covered three domains: a. structure in 3 dimensions: standards of organizational management and leadership, human resources and manpower, and expenses and facilities. b. process in 13 dimensions: examining and evaluating, diagnosing and identifying the result, planning, carrying out clinical measures and administering, evaluating, supporting patients and their well-being, establishing effective communication, cultural sensitivity, recording and report writing, patient s movement, nutrition, water and electrolytes, individual sanitary, security, and evaluating the risk. 2 Vol 8 (35) December Indian Journal of Science and Technology

3 Ghassem Abedi, Farideh Rostami, Aliasghar Nadi and Nasim Taheri In order to determine the reliability of the questionnaire, 30 copies of it were given to a group of nurses, who completed them, and the results were used Cronbach s alpha, and the total reliability was calculated to be In order to analyze the collected data, descriptive statistics (frequency, frequency percentage, histogram, measures of central tendency (mean), and distribution index of standard deviation) and inferential statistics (Kolmogorov-Smirnov test for normality of the data, one-sample T-test, and parametric tests) were employed. 3. Results As indicated in Table 1, all variables are normal; therefore, they were examined using parametric tests. In so doing, one-sample T-test was employed in order to examine the state of the study variables. Since the items were based on a 5-point scale (very low, low, average, high and very high), the calculated means were compared with the constant value of 3 (mean, median or average). The null hypothesis was the equality of the mean with 3, and when Table 1. The normality test of the study variables Variables Kolmogorov-Smirnov Statistic Sig. Test Result Managerial Standards and Organizational Leadership Normal Human Resources Normal Expenses and Facilities Normal Structure Normal Clinical Specialty Normal Nurse as a Manager Normal Nurse as an Instructor Normal Nurse as a Researcher Normal Nurses Professional Ethics Knowledge Normal Examination and Evaluation Normal Specification of the Result Normal Planning Normal Clinical Measures and Administration Normal Evaluation Normal Support and Well-being of the Patient Normal Effective Communication Normal Cultural Sensitivity Normal Recording and Report Writing Normal Patient s Movement Normal Nutrition Normal Water and Electrolyte Normal Individual Sanitary Normal Security and Risk Evaluation Normal Process Normal Patient s Satisfaction Normal Avoiding and Preventing the Occurrence of Complications and Events Normal Result Normal Vol 8 (35) December Indian Journal of Science and Technology 3

4 Determining the Relationship between Nurses Professional Ethics and Observance of Nursing Care Standards the calculated t was high or the sig value was lower than 0.05, the null hypothesis was rejected. As observed in Table 2, the results of one-sample T-test and comparison between the obtained means indicated that the variable mean of management standards and organizational leadership was 3.24, SD was 0.60, t value was 4.87, and sig. was lower than 0.05; therefore, the null hypothesis was rejected. As a result, management Table 2. Examining the state of the variables based on one-sample T-test Variables The Constant of Test 3 Test Result State Managerial Standards and Organizational Leadership Human Resources Expenses and Facilities Mean SD t-statistic df Probability Value Rejected Above Average Accepted Average Rejected Above Average Structure Rejected Above Average Clinical Specialty Accepted Average Nurse as a Manager Nurse as an Instructor Nurse as a Researcher Nurses Professional Ethics Knowledge Examination and Evaluation Specification of the Result Rejected Below Average Rejected Above Average Rejected Above Average Accepted Average Rejected Above Average Accepted Average Planning Rejected Above Average Clinical Measures and Administration Accepted Average Evaluation Rejected Above Average Support and Well-being of the Patient Effective Communication Cultural Sensitivity Recording and Report Writing Rejected Above Average Rejected Above Average Accepted Average Rejected Above Average (Continued) 4 Vol 8 (35) December Indian Journal of Science and Technology

5 Ghassem Abedi, Farideh Rostami, Aliasghar Nadi and Nasim Taheri Table 2. Variables The Constant of Test 3 Test Result State Patient s Movement Mean SD t-statistic df Probability Value Accepted Average Nutrition Rejected Below Average Water and Electrolyte Individual Sanitary Security and Risk Evaluation Accepted Average Rejected Below Average Accepted Average Process Rejected Above Average Patient s Satisfaction Avoiding and Preventing the Occurance of Complications and Events Continued Rejected Below Average Rejected Above Average Result Accepted Average standards and organizational leadership were higher than average. The mean of human resources was 3.05, SD was 0.54, t value was 1.28, and sig. value was over 0.05; therefore, the null hypothesis was accepted. As a result, standards of human resources were average. The average standard of expenses and facilities was 3.36, SD was 0.89, t value was 4.84, and sig. value was lower than 0.05; therefore, the null hypothesis was rejected. As a result the standard of expenses and facilities was over average. Other variables are also observed in this Table. Pearson Correlation Coefficient was utilized in order to examine the relationship between the nurses knowledge of professional ethics in three domains (structure, process, and result). As observed, correlation coefficient between nursing ethics knowledge and standards of nursing care in the domain of structure was which is significant at an error level of Correlation coefficient between nursing ethics knowledge and standards of nursing care in the domain of process was which is significant at an error level of And the correlation coefficient between nursing ethics knowledge and standards of nursing care in the domain of result was which is not significant at an error level of According to the results presented in the above Table 4, it can be concluded that with an improvement in nursing ethics, nursing standards Table 3. The results of Pearson Correlation Coefficient to examine he relationship between the nurses knowledge of professional ethics and health care standards Variable Nurses Knowledge of Ethics Result Pearson Correlation Coefficient Sig. Structure Significant Process Significant Result Not Significant Table 4. Ranking the nursery knowledge using Friedman Test Variable Mean Rank Priority Clinical Specialty st Nurse as a Manager rd Nurse as an Instructor nd Nurse as a Researcher th will improve especially in the domains of structure and process. According to the results of analyzing the respondents views, the first priority was related to nurse in clinical specialty and the last to nurse as a researcher. Vol 8 (35) December Indian Journal of Science and Technology 5

6 Determining the Relationship between Nurses Professional Ethics and Observance of Nursing Care Standards 4. Discussion and Conclusion The results of the present study indicated that there is a correlation between the rate of professional ethics knowledge and nursing standards in hospitals. Given the nurses ethical learning and its relationship with their professional requirement in order to observe health care standards, it should be significantly noticed that nursing graduates need be provided with quality training on ethics during their internship so that they can acquire necessary skills and take responsibilities in the future. Training and improving human resources is a strategic measure which at individual level empowers the individuals and give them value, at organizational level it improves and extends the organization s performance and efficiency, and at national and international levels it enhances productivity and economic and social profits. Numerous similar studies that have been carried out in Iran and other countries investigated the relationship between professional ethics knowledge and observance of nursing standards. The results of the present study are in agreement with those of the study conducted by Kalaitzidis who indicated that there is a direct relationship between learning professional ethics knowledge and better performance of nurses regarding care standards 17. According to him, a large number of nursing students believed that training ethics is one of the requirements for professional and care performance. Numminen also reported similar results, which confirm the results of the present study 18. The results of the domestic studies also indicated the importance of this relationship. In a similar study, Dehghani et al. concluded that holding training courses of professional ethics and related conferences had an effective role in enhancing the observance of nursing professional standards and criteria, which confirms the results of the present study 19. Professional ethics knowledge is so important that Hashemi and Parsyar stated changing the content of curriculum of professional ethics training is necessary to deal with the unfavorable performance of professional ethics among nursing students 20. In their study, Korkmaz and Erdil indicated the relationship between professional ethics knowledge and observance of nursing standards 21. A deeper look into the issue reveals the direct relationship between professional ethics knowledge and observance of nursing standards. On the other hand, Borhani et al. concluded that training ethics is effective in enhancing nursing students knowledge about ethical issues and practical use of them in working environment, which confirmed the results of the present study. Therefore, understanding the level of acquired knowledge during academic periods and inservice programs increases the knowledge of the nurses about skills necessary for heath care in hospitals, this in not only effective in ensuring mental security but it can also accelerate the patient s recovery process and bring about the nurses job satisfaction. Therefore, appropriate changes that is compatible with necessary skills to ensure patient s security, such as changing syllabus, facilities, equipment, and theoretical and clinical educational environment, can enhance the ethics along with necessary skills in order to ensure the patients security by nurses in hospitals. Moreover, in order to enhance the quality of service provision and observance of the utmost level of standards, serious steps need to be taken regarding enhancing the nurses practical and ethical capacity, which should be taken into comprehensive consideration of authorities and current teaching methods and nursing facilities need to be reviewed and replaced with the latest scientific and experienced methods of other countries 13, Reference 1. Sarmadi M, Shalbaf O. Professional ethics in total quality management. Ethics in Science and Technology. 2006; 2(3,4): Izadikhah A, Changiz, Yamani N, Mirshahjafarey I. Developing codes of ethics for clinical medicine educators. IJME. 2013; 6(1): Ghoorchiani F, Barati MA, Ghorgi HA, Khatami FAM, Haghani H, Gholdust MF. Observance of nursing ethics from the perspective of nurse and patients in a teaching hospital in Tehran University of Medical Sciences. Medical Ethics. 2013; 7(23): Abedi Gh, Ebadattalab E, Rostami F. Analyzing quality gap of nursing services in the selective academic hospitals. International Journal of Collaborative Research on Internal Medicine and Public Health. 2012; 7(10): Jormsri P, Kunavicticul W, Chaowalit KA. Moral competence in nursing practice. Nursing Ethics. 2005; 12(6): Sanjari M, Zahedi F, Aala M, Peymani M, Parsapour A, Aramesh K, Maddah S. Nursing code of ethics. Journal of Medical Ethics and History of Medicine. 2011; 5(28): Amado GR. Ethical decision-making processes used by health care providers. Journal of Advance Nursing Nov.; 18(11): Patenaude J, Niyonsenga T, Fafard D. Changes in students moral development during medical school: A cohort study. CMAJ. 2003; 168(7): Vol 8 (35) December Indian Journal of Science and Technology

7 Ghassem Abedi, Farideh Rostami, Aliasghar Nadi and Nasim Taheri 9. Auvinen J, Suominen T, Kilpi LH, Helkama K. The development of moral judgment during nursing education in Finland. Nurse Education Today Oct.; 24(7): Ersoy N, Guendogmus UN. A study of the ethical sensitivity of physicians in Turkey. Nursing Ethics Sep.; 10(5): McPhail K. The other objective of ethics education: Re-humanising the accounting profession: A study of ethics education in law, engineering, medicine and accountancy. Journal of Business Ethics. 2001; 34(3): Weaver K. Ethical sensitivity: State of knowledge and need for future research. Nursing Ethics Mar.; 14(21): Borhani F, Alhani F, Mohammadi I, Abbaszadeh A. Professional nursing ethics: It s development and challenges. IJME. 2009; 2(3): Wehrwein TA. Moral reasoning and ethical decision-making in beginning baccalaureate nursing students. United States, Michigan: Wayne State University; Rodmell FE. Ethics in nursing: The development of an educational model for practice. United Kingdom: University of Surrey; Kelly B. The professional values of English nursing undergraduates. Journal of Advance Nursing July; 16(7): Kalaitzidis E, Schmitz K. A study of an ethics education topic for undergraduate nursing students. Nurse Education Today Jan.; 32(1): Numminen O, Kilpi LH, Arend DAV, Katajisto J. Comparison of nurse educators and nursing students descriptions of teaching codes of ethics. Nursing Ethics Sep.; 18(5): Dehghani A, Kermanshahi MKS. Evaluating of compliance with professional ethical standards in nursing practice from Nursing Staff s Viewpoints in Tehran University of Medical Sciences. Modern Care, Scientific Quarterly of Birj and Nursing and Midwifery Faculty. 2012; 9(3): Hashemi F, Parsyar N. Assessment of professional moral practice of nursing student from perspective of nurse-practitioners in Shiraz University of Medical Sciences. Abstract of articles in 10th general congress in medical sciences education in Shiraz University of medical sciences. Green Journal: Specific Journal in Medical Sciences Education. 2009; 6: Erdil F, Korkmaz F. Ethical problems observed by student nurses. Nursing Ethics Sep.; 16(5): Ulrich CM, Taylor C, Soeken K, O Donnell P, Farrar A, Danis M, Grady C. Everyday ethics: Ethical issues and stressing nursing practice. Journal of Advanced Nursing Nov.; 66(11): Shoorideh AF, Nabizadeh Z, Khazaei N, Majd AH. Correlation between Nursing Managers Delegation and Nurses Organizational Commitment from the viewpoint of nurses working in teaching hospitals of Isfahan University of Medical Sciences. Scientific Journal of Pure and Applied Sciences. 2014; 3(8): DOI: / sjpas.v3i Ilkovska B, Kotevska B, Trifunov D, Trajkovska M. Correlation between serum levels of hepcidin and ferritin in patients with metabolic syndrome in R. Macedonia. Scientific Journal of Review. 2014; 3(11): DOI: /sjr. v3i Tabarestani AM, Shoorideh AF, Jahani M, Mahmoud NPN, Majd HA. Creativity and effective factors on hospital nurses creativity. Scientific Journal of Pure and Applied Sciences. 2014; 3(8): DOI: /sjpas.v3i Vol 8 (35) December Indian Journal of Science and Technology 7

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